Individual
DR. MARY C CARLILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 458-2404
(918) 458-2405
Mailing address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 458-2404
(918) 458-2405
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
28123
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28123
OKLAHOMA MEDICAL LICENSE
OK
01
—
41590
OKLAHOMA BUREAU OF NARCOTICS
OK
Enumeration date
07/31/2006
Last updated
03/07/2023
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